W«pphyi^«™ffl liHl II 1 ' ' ' —■ A N INQUIRY INTO THE Causes of §&tttMty. i \ AN I N Q"U I R Y INTO THE Causes of §s>tmlitv I N BOTH SEXES; WITH ITS METHOD OF CURE. CITIZEN OF THE STATE OF VIRGINIA. ------- creavit Deus hominem ad imaginem suam, ad imaginem Dei creavit ilium, masculum et faeminam creavit eos. Benedixitque illis Deus et ait; cresclte et multiplicamini et replete terram. ^tXltiiH, cap. i. ver. 2$, i ■■WBWICS3EHW*—" P!)tlat>elpl)ia: Printed by E. OSWALD, No. 179, South Second-Street. :.;,dccyxcvu. INAUGURAL DISSERTATION, SUBMITTED TO THE EXAMINATION OF THE Rev. John Ewing, S. T. P. Provost; THE TRUSTEES AND MEDICAL PROFESSORS OF The WLnMtsity of $ennei}?Mnta, FOR. THE DEGREE OF Doctor of Medicine, On the TWELFTH DAY of MAY, 1797. Ok Woman! on a melancholy Strain is my sad Soul employed. West's Jphigenia. T O JAMES WOODHOUSE, M. D. Professor of Chemistry IN The SSnfoersttp of $ennspftmuta* THIS DISSERTATION IS RESPECTFULLY INSCRIBED, AS A PUBLIC TESTIMONY OF RESPECT AND ESTEEM, BY HIS SINCERE FRIEND THE AUTHOR. INTRODUCTION. 1 HE anxiety of mind, which appears to be universally connected with unfruitful marriages, is found to be the cause of as much evil in the world, as any of those diseases to which we are liable. Although the lives of the unhappy sufferers may not be in much danger, yet Physicians should be induced to a diligent investigation of the causes of Barrenness; for upon inquiry it appears, that many causes of Sterility are not without a remedy, many persons subject: to this affection, having been cer- tainly cured by the good old women. The Phvician then, who is attentive to the several causes of this complaint, must be more adequate to the treating it in a proper manner, than any other person. This consideration alone would be a sufficient induce- ment for engaging on a subject of this importance. We find little mention made of Sterility, either by the ancient or modern Physicians. B 8 What we can collect from the former,concerning its causes or its cure, is so very unsatisfactory, that we are left nearly in the dark. I have not been able to find, that any of the moderns have treated of it methodically. Dr. Cullen has omitted it in his Synopsis of Nosology, but has mentioned it in a list of those disorders that he has not taken much notice of, because he was not pos- sessed of a proper description of them. This dissertation is delivered to the world with ma- ny imperfections ; and I beg the indulgence of the can- did reader, and hope that he will not suppose the author has been led on by vanity or ambition, but that he has been guided altogether by one motive, that of doing good. DISSERTATION ON STERILITY. XT will be necessary for us, in the first place, to consider the method nature takes for the production of the Foetus, that we may the better understand the causes that may prevent the fulfillment of her designs. Although much attention has been paid to this subject, by the anci- ent and modern Physiologists, yet they have left us so many doubts concerning it, that it is involved in much obscurity. I shall endeavour to lay before my reader a sketch of the difference of sentiment that exists between the Physicians of the present day ; for it would be useless to mention the various opinions that might be collected from the ancients. They would only fhew the fertility of the imagination, and tend to prove what has been said by a celebrated Philosopher, that man is a mere credu- . lous animal.* We may reckon the opinions concerning generation under two heads ; NOTE. * In proof of this we may mention, that Drelingcourt, a teacher of the celebrated Boerhaave, has collected near three hundred conjec- tures from the ancients on this subject, all of which have been believ- ed at one time or another. 10 Evolution and Epegenesis. By Evolution is meant, the existence of organic germs.* By Epegenesis it is supposed that the prepared, but unorganized rudiments of the foetus, begins to be gradu- ally organized when it arrives at its place of destination, under certain necessary circumstances. The Physiologists who believe in Evolution, are di- vided among themselves, to which of the parents to give the foetus. Liewenhoeck, Heartzoeker and others, endea- vour to prove, that it belongs to the male. The existence of living beings in the male semen, is the strongest proof they bring forward in support of this opinion. This last mentioned Physiologist, has endeavoured to impose on the world, by declaring that he discovered the foetus fold- ed up in the body of the animalculae, in the same man- ner that it is found in the womb, in time of gestation. But this is contradicted by the observations of all men, who have followed this author. The similarity of ap- pearance of the animalculae in the semen of different classes of animals, makes it very probable, that they are not the offspring of those animals. And the following celebrated experiment of the Abbe Spallanzani, puts the NOTE. * According to this doctrine, the germ of every animal, and of every plant that now lives, or is yet to live, were all created at the be- ginning of the world. The men and women who are now in exist- ence, and who are to live a million of years hence, were pent up in the ovaria of our common mother Eve. If matter almost beyond the possibility of a doubt. Hav- ing procured the semen of some male Frogs which swarmed with thousands of animalculae, he separated some of the seminal liquor, and found that it answered the end of fecundation, as well as when it was full of those beings- This convinced him that they were not necessary to the formation of the offspring. Other Phy- siologists believe, that the Female contains the offspring in the ovaria. Among these the venerable Hailer, and the ingenious Spallanzani, stand foremost. What lea* Dr. Hailer to embrace this opinion was, his discovery of the connection that exists between the membrane and vessels of the chick and the yolk, soon after incubation. This he considered as an argumentum crucis, in favor of the co-eval existence of the chick with the yolk, which u before the connection with the cock. A strong objection to this opinion is, the possibility and probability of an anastomosis which may be produced between the chick and the yolk after incubation, in the same manner it t^kes place between the Placenta and Uterus after the descent of the ovum into this viscus. The manner in which Hailer has attempted to over- throw this objection, is by denying that the small and tender vessels of the embryo, should be capable of anas- tomosing with the great blood vessels of the yolk. The strongest proofs which Spallanzani brings for- ward to prove that the offspring are contained in the ova- 12 iia of the female are,—First, That the coloured specks observable in the spawn of Frogs, appear to the senses to be the same after faecundation as before. Secondly. That at a certain time after faecunda- tion, they partook of growth, and the coloured specks appeared to be changed into Tadpoles. And Thirdly, That the spawn had no shells, which he conceived they should have, to be eggs. There has been as much controversy concerning the manner faetation takes place. Blumenbach and others imagine, that it begins in the womb. The dissections of brutes by the most eminent Anatomists, with a direct view to elucidate this point, ascertain it as far as such evidence can be admitted. In the dissections of small animals by De Graff, he found no discernable alteration in the ute- rus during the first forty hours after coition, but a gra- dual change was perceivable in the ovaria, and what he supposed to be the ripened origin of the future animal. At the end of that time it lost its transparency, became o- pake and ruddy, and the fimbriae were found closely ap- plied to the ovaria, and the cavity from which the ova had been expressed was discernable, and the third day the ova could be seen in the uterus. Extrauterine fceta- tion also confirms this opinion, for in those cases we can- not suppose the ovum to descend into the womb, and after- wards to ascend into the abdomen. This being ascertain- ed, the greatest difficulty still exists. How does the se- men arrive at the ovaria ? By some it is supposed to be absorbed and carried through the circulating mass, and *3 + that by its specific action it impregnates the ovum. This was probably conjectured, because there appeared not a more probable method of its arriving there. It cannot be by the force acquired in its discharge from the male, as has been supposed by some, for the na- tural impediment from the structure of the parts, would resist a much more powerful force than can be given to the semen. This secret operation of nature will probably remain a matter of opinion, as no experiment can ever ascertain it in the human subject, and analogy has shown that nature is very various in different animals, some be- coming impregnated out of thebody, as Fishes, Frogs, &c. The most reasonable supposition to me is, that the Fallo- pian tubes, take on a kind of peristaltic motion, and thus perform a double office. We might suppose that this could easily be the case, seeing that all the vessels of the body have the power of a retrograde motion. It has been said by some, that the venereal orgasm is not necessary to a fruitful connection of the sexes. The strongest argument they have is, the famous experi- ment of Spallanzani, who artificially impregnated a Bitch by means of a syringe, filled with the semen of a Dog. But we can determine nothing from this experi- ment, as the Abbe has not told us whether much irrita- tion was produced or not, and very little might have been necessary, as the animal was highly excitable at the time. We know likewise that when the female is not ca- pable of gratification from debility, or against inclina- tion, she is scarcely or ever fruitful. OF THE CAUSES OF STERILITY. iJARRENNESS is the effed, not the cause of diseases. We will therefore mention the complaints which produce it. We will likewise endeavour to ascer- tain their proximate causes, that we may be able to re- move them. We shall arrange the diseases which we are to consider, under two heads. First, Those which affect the whole system ; and, secondly, those which are of a local nature. Under the first head we might mention all diseases of a violent kind, whether they are seated in the vascular, nervous, or muscular system. They prevent pregnancy, by instituting a stronger impression on the parts, which are necessary to perform the function of gene- ration, than can be made by the semen of the male. These affections so soon terminate either in health, death, or some other disease, that they can scarcely ever be examin- ed into with a view to the question we are considering. I shall confine myself to those that are more the immediate causes of Barrenness by affecting the uterine system. And first of those which have the effect of interrupting the menstrual discharge. i5 It appears to be the monthly flow of the Mer\ses that capacitates the human female to become pregnant, at all seasons of the year; and it has been observed, that preg- nancy very generally takes place soon after one of the pe- riods of their occurence. The menstrual discharge may be interrupted by two different states of the system, which are designated by the names of Suppression and Retention. The first is their disappearance after they have taken place, when it does not proceed from pregnancy. The latter, when the menstrual flux does not begin to flow at that time of life which it should make its appearance. The first of these diseases consists in a preternatural resistance made to the blood by the vessels of the uterus, and the arterial system in general is found to be too highly toned. This I infer from the pulse, which has too much action, which lays the patient liable to haemorrhagies from the nose, lungs, stomach, and other parts of the body. Retention is the opposite of Suppression, and de- pends on a want of irritability in the general, as well as uterine system, and is attended with a consequent cronic debility. The celebrated Dr. Cullen thinks, that it is to be referred to a certain affection or state of the ovaria ; but what is precisely the nature of this affection, or what are its causes, he does not pretend to determine. But with due respect to this great man, I shall differ in opinion, and suppose that the state of the ovaria is rather an effect, than the cause, of the disease. This I conclude to be the case from its being a general, and not a local complaint, which it should be if the ovaria were in fault j and if any C i6 part should be primarily affected, it is the stomach, with dyspepsia, which I believe is a universal concomitant of this disease. Of the causes that are of a local nature we may e- numerate the following: First, A Lusus Naturae. Secondly, derangements from accidents, and local diseases, which impede the passage of the semen : And Thirdly, local debility. Morgagni has shown us, that some women are so defective, as to have no womb; in others he found this viscus so very small, as not to exceed the size of a child's. He has also mentioned an instance where no ovaria were found ; and we have a number of cases recorded in the histories of morbid anatomy, in which nature was irregu- lar in the disposition of the parts, subservient to the pur- pose of generation. In pregnancy the pressure of the gra- vid uterus on the ovaria and tubes against the Ossa In- nominata have produced irrecoverable injury. This sometimes takes place in parturition, and may probably be the reason, that we see so many instances of sterility after the first delivery, where we cannot discover any other probable cause. Issues, Ulcers, Cancers, and Schir- ri likewise produce barrenness. Vanswieten makes men- tion of several cases of Schirri that produced this effect, which were not discovered until after death. l7 Nothing, says Boerhaave, is more frequent upon opening the bodies of sterile women, than to find a schir- rus hardness of the ovary, or a distention of it with hy- datids.* Cancers are easily known by the shooting pain which attends them. Other Ulcers may be known if they are seated in the womb, by the touch. Hydropic af- fections of the ovaria, are not easily to be discovered, un- til they arrive at a considerable size. Leucorrhoea is another cause, and is probably pri-. marily a local disease, and dependent on debility. Dr. Cullen thought that this disease could exist but in a slight degree, without injuring the power of procreation. It is probable this state of debility prevents pregnan- cy, in that deluded part of the human race, called women of the town ; but their intemperance in strong drink may often have a share in producing the same ef- fect. This species of intemperance may act in some in- stances in the married state, but we know the male is not always rendered incapable of procreation by intoxication; witness the case of good old Noah, recorded in the Holy Scripture. Hitherto we have been considering the causes that act on the female, let us now advert to those which affect the male. We are very uncertain, whither there are NOTE. * Boerh. Le&. on The. of Pi.} s. Page 234. Vol. V. i8 any diseases which affect the general health of the male, so as to incapacitate him from procreation ; febrile diseas- es may so alter the secretion of the semen, as to produce this effect, but to treat of them is far from my intention. A watery semen has been supposed to produce an incapacity in the male; but what can be said of this with certainty, I cannot determine. We find those who live on low diet, as prolific, or more so, than those who live on high seasoned food ; witness the blacks of this country, and the fishermen who live on fish and oysters, &c. O f the local causes which affect the male are first, a Lusus Naturae, and secondly, defects from injuries and local diseases. Morgagni mentions cases where the ure- thra opened beneath the glans, and also where it opened on the back of the penis. A preternatural thickness of this organ, or its being too diminutive in size is to be con- sidered as causes. A number of other irregularities are mentioned by authors, as the narrowness of the orifice of the prepuce, and the tying down of the glans by the frcenum, in such a manner as not to admit a free dis- charge of semen. Injuries from accidents are likewise to be taken notice of, such as the loss of any of the genital parts which may be necessary for coition. The diseases that affect the genitals are various, as the class of Dysper- matismus of Nosologists, and the various species of ul- cers, which are to be known by inspection. OF THE SIGNS OF STERILITY. JLT will be a difficult matter to discover whether Sterility is present or not. If it is acquired, we must ad- vert to the several causes which produce it, many of which are so occult as not to be discovered. Those which de- pend on natural defects are still more obscure, as the health is not thereby injured. Morgagni has mentioned that it is probable, that those men who are naturally with- out hair on their bodies, will be found to be incapable of procreation; and the case of a man related by Valsalvi, who was naturally without hair, being in that situation, will tend to confirm the opinion. The same author fur- ther adds, that in the cases of three women, he was able to discover a perceptible difference in the cutis, which was preternatural from birth. In those cases nothing could be discovered that gave rise to this defect, yet the women were barren, although married to men of excellent con- - liiutions. On examination he found the cutis in one of those persons contrary to what we should have expected from her mode of life, age, and habit of body; it was by no means soft when touched. And in the other two he found the skin covered with a cuticf e, that was continually falling off in small scales. Our accurate author observes, that the habit of body of these persons was such, as to pro- duce a change in the secretion of the sebacious glands. OF THE CURE. j[\FTER we have discovered the cause of Barrenness, and know that it proceeds from any of the diseases mentioned, we direct our remedies according to the nature of the disorder we have to remove. We have already said, that many of the local complaints are of so occult a nature, as not to be easily discovered, and when found out, many of them are without a remedy. We are therefore not to expect cures in all cases, and in- deed but few of them comparatively speaking, according to the number which occur. Should suppression be the cause, we endeavour to remove it, and our fir^t indication is to lessen the preter- natural tone of the vessels of the uterus, which extends commonly over the whole vascular system, and is attended with plethora. This must be taken down by blood let- ting, and other depleting remedies. It is said that an op- posite state of the system may produce the same effe6t. Should this ever be the case, there will be no necessity of depletion. Our chief remedy, after the tone of the system is lessened, and the plethora removed, is the warm bath, or sitting over the steam of water, which is an excellent mode of applying this remedy, and which acts by relaxing the coats of the arteries, whilst the sti- 21 mulus of the warmth increases their action. Some Phy- sicians have advised stimulants to be administered with this intention, but they will scarcely ever be of service*, when.the remedv above recommended has failed. In case of retention, where there is a want of excite- ment, and the opposite state of the system prevails to that of suppression, our chief remedies are stimulants and to- nics ; the exercise of the lower limbs in walking or danc- ing is highly serviceable. The exercise of venery is re- commended as a stimulus to the uterus when it is admis- sible. Electricity is alco highly spoken of; the uterus may be stimulated by shocks passed through the pelvis. Th e same state of the system may produce barrenness, and the flow nott)e suppressed ; our remedies are the same, being such as promote strength, as aliment of a nutricious nature, the martial mineral waters, and the class of bitters. It was in this state of the system, that the ancient class of remedies, called sterilitas were of service, which were of a balsamic nature, and the nostrums of the present day for this affection, are of the stimulating kind. The prac- tice also of the good women of this, as well as some other countries, is the indiscriminate use of this class of remedies. Hasselquist informs us, that the Egyptian women drink a cup-full of clove water upon going to bed, for this com- plaint, and we may suppose not without success. Medicines will be of little service in barrenness that proceeds from local diseases, except when it is produced by local debility, in which case we should always endea- 22 vour to remove the exciting causes, and when this is done the strictest attention should be paid to cleanliness. The cold bath applied to the parts immediately affected will commonly remove this complaint. We cannot say much of the causes which affect the male. Impotency is generally considered as incurable. Jn case of too great irritability of the genitals, brought on by the baneful practice of Onanism, matrimony has been found to be of the most service, and the tonics re- commended by most authors, are not near so effectual, and often prejudicial. The knife must be used, when either the orifice of the prepuce is too small to admit the free discharge of the semen, or the glans too much tied down by thefrcenum. The affections of the testicles and penis by diseases, are to be treated as their different cases may require, according to the opinion of the Surgeon. f...', ^^f^Ii*!^-^^^ *!j-«[-#• '3i|l; %:fiji?ti|;-,F IliSlp^ ■$ fei-: 'y/A']iCl'.- ii-'.{::t'.:]. ■■ ■'.&■■:■:,■'.• : iyitlvijjIteKitiK!!'.